title: Macrolide therapy decreases chronic obstructive pulmonary disease exacerbation: a meta-analysis.
abstract: BACKGROUND
  Macrolide antibiotics have anti-inflammatory effects, and long-term administration may reduce chronic obstructive pulmonary disease (COPD) exacerbations.
  
  
  OBJECTIVE
  To investigate the effects of long-term treatment of macrolide therapy for COPD.
  
  
  METHODS
  We searched the PubMed and Embase databases to identify randomized controlled trials that evaluated the effect of macrolide therapy (of at least 2 weeks) for COPD. The primary outcome assessed was the frequency of acute exacerbations during follow-up.
  
  
  RESULTS
  Six trials involving 1,485 COPD patients were included in the analysis. Analysis of the pooled data of all 6 trials showed that macrolide administration reduced the frequency of acute exacerbations of COPD [risk ratio (RR) = 0.62; 95% CI 0.43-0.89, p = 0.01]. Subgroup analysis showed that only erythromycin might be associated with decreased COPD exacerbations (erythromycin: p = 0.04, azithromycin: p = 0.22, clarithromycin: p = 0.18). Moreover, macrolide therapy for 3 months did not significantly reduce the number of exacerbations (p = 0.18), whereas a beneficial effect was conclusive in the 6-month (p = 0.009) and 12-month (p = 0.03) treatment subgroups. In addition, nonfatal adverse events were more frequent in the macrolide treatment groups than in the controls (RR = 1.32; 95% CI 1.06-1.64, p = 0.01). However, related clinical factors had no influence on the overall result (p = 0.19). There was no publication bias among the included trials.
  
  
  CONCLUSIONS
  Macrolide therapy was effective and safe in decreasing the frequency of exacerbations in patients with COPD. Treatment might provide a significant benefit but only when therapy lasts more than 6 months.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China.
authors.forename: Guo-Yan
authors.initials: GY
authors.lastname: Yao
authors.forename: Yan-Liang
authors.initials: YL
authors.lastname: Ma
authors.forename: Mo-Qin
authors.initials: MQ
authors.lastname: Zhang
authors.forename: Zhan-Cheng
authors.initials: ZC
authors.lastname: Gao
mesh_terms: D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D018942:Macrolides